Maimonides Comprehensive Community Service Plan and Community Health Needs Assessment ( )

Transcription

1 Maimonides Comprehensive Community Service Plan and Community Health Needs Assessment ( ) This community health needs assessment and implementation strategy was approved by the Maimonides Medical Center Board of Trustees Executive Committee. Key Contacts: Kalpana Bhandarkar, MPH, MBA VP, Research and Health Services Initiatives Maimonides Medical Center Eric Scalettar, MPH SVP, Planning Maimonides Medical Center Maimonides Medical Center Hospital Community Service Plan ( ) 1

2 TABLE OF CONTENTS I. MISSION STATEMENT 3 II. DESCRIPTION OF COMMUNITY SERVED 3 III. PUBLIC PARTICIPATION 4 IV. ASSESSMENT AND SELECTION OF PUBLIC HEALTH PRIORITIES 5 V. THREE YEAR ACTION PLAN 8 VI. DISSEMINATION OF THE PLAN TO PUBLIC 14 VII. MAINTAINING COMMUNITY ENGAGEMENT 14 Maimonides Medical Center Hospital Community Service Plan ( ) 2

3 I. MISSION STATEMENT Maimonides Medical Center is Brooklyn s premier specialty care teaching hospital. We pioneer medical breakthroughs, boast state-of-the-art clinical and information technology, and oversee one of the City s largest training programs for residents and fellows. Maimonides regularly wins awards from independent evaluators for the quality of our care. Maimonides Medical Center s mission statement, affirmed by Maimonides Board of Trustees in March 2013, is: Maimonides Medical Center is dedicated to fostering healthy communities. We provide high quality, compassionate patient care and comprehensive community services. As a premier academic medical center, we are devoted to educating health care professionals, patients, families, employees and the communities we serve. We conduct research that improves the lives of our patients. We welcome patients of all faiths, and at the same time remain uniquely committed to serving the special health care needs of the Orthodox Jewish community, whose religious and cultural traditions help guide the provision of Maimonides services. II. DESCRIPTION OF COMMUNITY SERVED Maimonides Medical Center serves a richly diverse set of communities, primarily in Southwest Brooklyn. Maimonides historically has used a commonly accepted planning definition of service area for acute care hospitals based on the aggregation of inpatient discharges from surrounding zip codes. The zip codes comprising the first 50% inpatient zip codes are defined as the primary service area. The next group of zip codes comprising the next 25% of zip codes is defined as the secondary service area. Based on this planning definition the primary service area for Maimonides Medical Center is comprised of the following 6 zip codes; 11219, 11230, 11218, 11204, 11220, The following 6 zip codes comprise the secondary service area for Maimonides Medical Center; 11223, 11235, 11229, 11224, 11228, Approximately 95% of the inpatient discharges at Maimonides Medical Center are patients with a Brooklyn address. However, our catchment area has been quickly expanding and we are seeing patients come from a number of other zip codes throughout north and south Brooklyn. Maimonides catchment area is comprised of racial, ethnic and faith-based diversity. There is a large proportion of immigrants, with nearly 40% of residents in Borough Park being foreign-born. A review of local indicators published by the NYC Department of Health and Mental Hygiene shows that, generally, the community served by Maimonides is healthy. We attribute this, in part, to the healthy migrant effect which finds that first-generation immigrants tend to be healthier than their US-born counterparts on most measures including heart disease, infant mortality, tobacco use, suicide, and some cancer rates. 1 However, we recognize fully that there are unmet health needs in the communities we serve and specific health issues within particular communities that require more attention. 1 Fennelly, K. The Healthy Migrant Effect. Minnesota Medicine Mar;90(3):51-3. Maimonides Medical Center Hospital Community Service Plan ( ) 3

4 III. PUBLIC PARTICIPATION To add scientific rigor to the development of our comprehensive community service plan / community health needs assessment, Maimonides engaged the New York Academy of Medicine (NYAM), a research and evaluative organization based in East Harlem, to assist with the design and implementation of this assessment. To that end, NYAM assisted in the design of the key informant interview guides and approaches and facilitated each of the interviews conducted, at which, in nearly every interview, at least one Maimonides staff person was present. Each interview has been transcribed, reviewed and analyzed. NYAM will continue to assist Maimonides with the design and facilitation of focus groups, which will begin in November and will develop, in coordination with Maimonides, a final report summary. Separately, they will work on a toolkit for community health needs assessments, to be available widely next year, which will include template interview and focus group guides, and guidance on facilitation, available in particular to other hospitals and organizations that are looking for assistance. Given that our community health needs assessment fell under the category of human research, Maimonides (and separately NYAM) obtained approval from our respective Institutional Review Boards (IRBs). Quantitative Data. In addition, Maimonides Senior Biostatistician conducted a review of available quantitative data on key health indicators for our catchment area. Sources included: NYC DOHMH Epiquery Portal, Community Health Survey, NYS Perinatal Data, U.S. Census data and other sources. Qualitative Data. The qualitative component was structured around key informant interviews and focus groups. Twenty-eight key informants were interviewed and were representative among the communities served by Maimonides. Communities represented included Arab, South Asian, Orthodox Jewish, Christian, Muslim, as well as the following professions: physicians, behavioral health care providers, police detective, community board members, City Council member, labor management representatives, and a senior center administrator. Informants were invited by phone or and met in a convenient location to them. Interviewees signed consent forms. In November 2013, we invited all the key informant interviewees and/or representatives from their respective organizations to meet at Maimonides to review preliminary findings from our data collection, discuss our selected Prevention Agenda priorities, and proposed implementation strategies and provide feedback. A total of 50 people from a variety of organizations as well as ethnic and faith communities were invited and 25 people attended the meeting, which was hosted at Maimonides Medical Center. Individuals included a Rabbi, Pastor, Imam, Community Board representatives, a senior police officer from the 66 th Precinct, a senior representative from a care management and behavioral health care organization, labor representation, a girls school Board Chair, physicians, other community-based organizational representatives and Maimonides senior planning and administrative staff. The ethnic / faith-based communities represented at the meeting included: Orthodox Jewish, Arab (Muslim and Christian), Chinese, South Asian and Christian. The feedback received was extremely constructive and helpful in shaping our implementation strategies and additional partnership opportunities to advance health promotion and engagement in preventive care and needed treatment across communities in our catchment area. The group s feedback is integrated into the proposed implementation strategies described below. Maimonides Medical Center Hospital Community Service Plan ( ) 4

5 IV. ASSESSMENT AND SELECTION OF PUBLIC HEALTH PRIORITIES Maimonides serves a richly diverse catchment area comprised of numerous immigrant communities, faiths, and ethnicities. More than 40% of the immediate catchment area is foreign-born. Two-thirds are White, but this composite racial category includes Orthodox Jewish, Italian, Russian, Polish and others, many of them immigrants. One-quarter are Asian. Less than 2% are African American and 11% are of Hispanic origin (which can include those in the other categories). One-quarter of residents are 65 years old and above (compared with 22% for all of Brooklyn). Nearly 30% of residents are enrolled in Medicaid, 14% are uninsured (compared with 23% and 18% respectively for all of Brooklyn). 2 The source for the most available data on health indicators for residents of Brooklyn derives from the NYC Department of Health and Mental Hygiene. However, all the data available and presented below is not from recent years, but is used to obtain a high level sense of the status of residents in the communities we serve. It is not disaggregated by racial / ethnic community, so it is different to understand if there exist disparities or differences between communities. It is for this reason that we supplement this quantitative data with a comprehensive qualitative data collection as part of this assessment, described earlier. In 2012, 18% of those in Borough Park 3 surveyed reported their health status being fair or poor (compared with 34% in 2011 and 24% in 2010). The rate of those who reported having a personal doctor stayed relatively similar at around 13%, from 2011 to On maternal and infant health indicators, Borough Park sees better health outcomes, compared with Brooklyn, as demonstrated in the table below Borough Park Brooklyn Late or no prenatal care 11.8% 14.1% Premature birth rate 9.1% 12.5% Low birth weight rate 6.2% 8.5% Infant mortality rate 2.5% 4.6% Neonatal death rate 1.6% 3.0% The primary health challenges for the communities served by Maimonides are predominantly around chronic disease prevention and treatment. The indicators presented above, notwithstanding, there are a fair amount of chronic disease-related indicators that require further attention. The table below 6 shows this data over time, with some increases and other decreases over time. Generally, the indicators are better than Brooklyn overall, but there are certainly areas required for improvement. 2 U.S. Census. American Community Survey. 3 Data on Borough Park residents is used as a proxy for Southwest Brooklyn, with the disclaimer that this is not representative of all communities in Southwest Brooklyn and that there are disparities and differences between and among communities, information which is captured through the qualitative data component of our assessment. 4 NYC Department of Health and Mental Hygiene. Community Health Survey NYS Department of Health. Perinatal Data Profile. Vital Statistics Data for Updated March NYC Department of Health and Mental Hygiene. Community Health Survey Maimonides Medical Center Hospital Community Service Plan ( ) 5

6 Borough Park Brooklyn Obese Hypertension (ever) Blood pressure medication (ever) Blood pressure medications (now) High Cholesterol Cholesterol Medications Diabetes Ever Current Smoker Asthma Ever Asthma Now In review of this data, there are apparent oddities in the data presented for On further review, there were no reported sample size changes or notes by the NYC DOHMH that the survey questions had changed. That notwithstanding, we have still chosen to report point to point changes in some of the data presented above that feed into our choice of Prevention Agenda priorities (i.e. from 2010 to 2012). These include those highlighted above: slight increases in asthma rates and obesity rates. The data above on blood pressure medications ever and now are hard to discern. Although the reporting of prescriptions of blood pressure medications declined from 2010 to 2012, the self-report of hypertension rose during the same period. With respect to preventive care, the percent of older adults who did not obtain / receive a flu vaccine rose from 42% in 2010 to 55% in Part of this lagging take up rate could be related to declination rates due to suspicion or fear of vaccines, something commonly noted in many of the interviews we conducted. Our key informant interviews illuminated a lot of the key health and social issues (that affect health and well-being). A summary of these items is below: Prevalence of chronic diseases high, consistent with general population (heart disease, diabetes, hypertension, asthma and obesity) Smoking rates are high in certain communities Smoking remains largely acceptable in Arab and Asian communities Lung cancer is significant concern, particularly in the Chinese community Older adults face serious health and social issues Depression, Multiple co-morbidities, Risks of polypharmacy, Difficulties in care coordination / multiple re-admissions, and Social isolation Lack of engagement in preventive services Immigrant populations may not be accustomed to seeking preventive care Lack of materials in appropriate languages represents a barrier to health information Limited time for accessing health care, except when absolutely necessary Concerns around childhood vaccine acceptance in several population groups Maimonides Medical Center Hospital Community Service Plan ( ) 6

7 In some communities, difficulties engaging patients in cancer treatment due to cultural beliefs Stigma around diagnosis and treatment seeking for mental illness In some cases, accessibility to behavioral health services is limited e.g. for children Lack of culturally-appropriate mental health services Urgent need to coordinate social services and supports to meet needs of and enhance stability for individuals with serious mental illness Co-occurring but often untreated substance abuse Limited integration of mental health and substance abuse providers They don t know about the preventive care You go to the doctor when you are sick. If somebody is healthy, why should they go to doctor? This is [the] mentality. - Community-Based Physician There [are] certainly cultural issues of some communities that are much harder The idea of getting mental health treatment, there s a lot of stigma around that. - Behavioral Health Services Provider We did a study looking at geriatric [older adult] patients and their medication lists. [We] found that there was essentially no correlation between what the patient thought they were on, what the primary care doctor thought they were on, what their specialist thought they were on, and what their self-identified pharmacy thought they were on And while the specialists generally try and coordinate with the primary care providers, it s not as successful as it could be. - Geriatrician..Doing these educational seminars and exposing [the community] to what is there and let them know what is available for them is really an eye-opener for them [W]hen the symposium is finished, there are a large number of people just standing around wanting to ask a question. - Patient Representative, Maimonides Maimonides Medical Center Hospital Community Service Plan ( ) 7

8 As a result, and as agreed at the November meeting described above, we have selected a focus on the following three Prevention Agenda priorities: Prevent Chronic Diseases Promote Healthy Women, Infants and Children Promote Mental Health and Prevent Substance Abuse These three priorities relate both to the concerns and disease prevalence and health care needs in our community as well as the strengths of our institutional services, human capital and partnerships with other providers and organizations. In addition, although we don t have local data on childhood vaccination rates, we have anecdotal data from the key informant interviews that in some communities, families either abstain from or reduce the amount of vaccinations their children receive, thus potentially revealing a disparity in childhood vaccination rates among different ethnic communities. This information was confirmed by both a Pediatrician interviewed and some community-based leaders and is particularly prevalent in the Orthodox Jewish community. The NYC DOHMH in a June 2013 alert confirmed a measles outbreak in Brooklyn where more than half of children affected (28 out of 40) lived in Borough Park. Due to this outbreak and lower vaccination rates among Orthodox Jewish children, the agency recommended accelerated vaccination schedules to reduce transmission risk among unvaccinated children living in large families and sometimes in crowded residential dwellings. 7 Compounded, a relatively low flu vaccination rates in our catchment area among older adults may increase the risk for serious morbidities associated with the flu. Thus, we will also include in our implementation strategy a focus on reducing the disparity in childhood vaccination rates between children in our catchment area and those in other areas of Brooklyn and NYC and also aim at improving flu vaccination rates for elderly adults in our catchment area to move closer to meeting the Take Care New York target of 80%. V. THREE YEAR ACTION PLAN Maimonides has developed strategies for health promotion and advancement of its patients and community members in essentially two parallel and, often, interlacing tracks. First, Maimonides is working with the NYC Department of Health and Mental Hygiene as described below, implementing interventions that are generally internal to the hospital and patient-facing. Second, Maimonides will sustain and adopt new, additional implementation strategies to advance health promotion and preventive care that are more community-facing, also described below. Maimonides has actively participated in partnerships with the NYC Department of Health and Mental Hygiene for many years. The hospital was one of the original Take Care New York Hospitals in New York City. Similarly, Maimonides has signed up to become a NYC DOHMH Prevention Partner, having selected 5 community health intervention activities, 4 of which align with our selected Prevention Agenda priorities and 1 which relates to a fourth Prevention Agenda priority. 7 NYC DOHMH. Alert #15: Update on Measles Outbreak: New Vaccination Recommendations. Available at health29ssl.nyc.gov/sites/nychan/lists/alertupdateadvisorydocuments/measles%20update_june%204_2013_final%20ver SION.pdf Maimonides Medical Center Hospital Community Service Plan ( ) 8

9 Maimonides selected the following five interventions and will implement the specified intervention components and report measures described in the table below. Maimonides will draw on the NYC DOHMH as needed for technical assistance. It should be noted that these interventions all rest within the confines of the hospital and its service provision. They will be implemented by hospital clinical and administrative staff and are focused generally on patients that receive care at the institution. Maimonides Medical Center Hospital Community Service Plan ( ) 9

10 Prevention Agenda Priority Prevent Chronic Disease NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE TAKE CARE NY IMPLEMENTATION INITIATIVES Community Health Intervention Intervention Components Example Measures Activity Support the development and a. Support the placement of DOHMH ads i. Number of media placement of anti-obesity education promoting healthy eating and active living in placements / media campaigns. our hospital Prevent Chronic Disease Prevent Chronic Disease Prevent HIV/STDs, VPDs, and other Healthcare Associated Infections Promote Mental Health and Prevent Substance Abuse Adopt Healthy Hospital Food Initiative Screen and counsel patients to quit smoking Ensure routine HIV testing in emergency departments and all outpatient clinics Engage patients with first episode psychosis into quality outpatient care a. Adopt NYC Food Standards, evidence-based nutrition criteria for cafeterias, vending machines and patient meals a. Establish routine screening for smoking and cessation counseling among inpatients and outpatients b. Fully implement Tobacco-Free Hospitals Campaign requirements a. Offer all patients of unknown HIV status between the ages of a voluntary HIV test a. Identify patients hospitalized or seen in an emergency department with psychosis with no previous history of psychosis b. Assist patients and families by connecting them to outpatient mental health care after discharge and ensuring they stay engaged in care for at least three months i. Number of standards fully implemented in each of the four NYC Food Standards categories i. Number of persons screened ii. Number of tobacco user / smokers given an intervention i. Percent of eligible patients offered an HIV test and HIV tested ii. Number of patients who test HIV patients i. Number of patients with first episode of psychosis who have greater than 3 outpatient visits in the three months following hospitalization ii. Readmission rate of patients with first episode psychosis Maimonides Medical Center Hospital Community Service Plan ( ) 10

11 Described below are the proposed interventions Maimonides will implement within each of the three selected Prevention Agenda priorities that are more community-focused. PRIORITY AREA 1: PREVENT CHRONIC DISEASES Proposed Strategies Performance Measures Data Sources Frequency of Review Number of symposia sessions held by disease / issue focus and by neighborhood Community outreach symposiums in Southern Brooklyn focusing particularly on heart disease, diabetes and cancer prevention and treatment, in partnership with local community- and faithbased organizations Maimonides Department of Community Relations data Operating a NYS-designated Health Home, the Brooklyn Health Home, providing care coordination to chronically ill populations (including a particular focus on seriously mentally ill individuals) Regular performance measures integrated into normal program operations including enrollment data (e.g. # engaged, # consented to participate) and outcome data (pre- and post- admission data) Health IT system serving as the backbone of the Health Home (e.g. GSI Health / TREAT care coordination platform) Train community-based organizations to provide basic health education around chronic diseases, including information on the importance of diet, physical activity, and smoking cessation as well as accessing preventive care services Ensures linguistic and cultural competency and accessibility of material Helps build capacity of local organizations to conduct health promotion Number of CBOs trained by Maimonides staff to deliver health promotion activities within their own community-based settings Number of health education activities held by these trained staff CBO reports Provide relevant information to schools to educate children on appropriate preventive health care practices Number of schools with which a meeting transferring information and best practices was held Maimonides Department of Community Relations Maimonides Medical Center Hospital Community Service Plan ( ) 11

12 PRIORITY AREA 2: PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN Proposed Strategies Performance Measures Data Sources Frequency of Review Maimonides volunteer doula program, offering doula services to any patient at no cost to patient / family, which include services during the prenatal and postpartum periods as well as labor Number of mothers served Maimonides doula program (run by N Shei Cares, a communitybased organization) Continue to provide accessible prenatal services, including high-risk services, and high risk neonatal intensive care for high risk neonates around the borough Prenatal care access rates NYS DOH Perinatal Data Profile Train community-based organizations to provide basic health education around: The importance of prenatal and postpartum care Parenting best practices Preventing / reporting child abuse and neglect Number of CBOs trained by Maimonides staff to deliver health promotion activities within their own community-based settings Number of health education activities held by these trained staff Maimonides Department of Community Relations data Provide relevant information to schools to educate children on appropriate preventive health care practices Number of schools with which a meeting transferring information and best practices was held Maimonides Department of Community Relations data Maimonides Medical Center Hospital Community Service Plan ( ) 12

13 PRIORITY AREA 3: PROMOTE MENTAL HEALTH AND SUBSTANCE ABUSE Proposed Strategies Performance Measures Data Sources Frequency of Review Operating a NYS-designated Health Home, the Brooklyn Health Home, providing care coordination to chronically ill populations (including a particular focus on seriously mentally ill individuals) Regular performance measures integrated into normal program operations including enrollment data (e.g. # engaged, # consented to participate) and outcome data (pre- and post-admission data) Health IT system serving as the backbone of the Health Home (e.g. GSI Health / TREAT care coordination platform) Improve capacity of pediatric behavioral health services to reduce wait time until next available appointment Average wait time until next available appointment (in days) Maimonides Department of Psychiatry Administrative Data Improve linguistic diversity of behavioral health clinicians Deepen and expand partnerships with care management and behavioral health providers in Southern Brooklyn to ensure timely referrals and accessibility for our patients Number of languages in which behavioral health services at Maimonides are delivered Number of partners in Brooklyn Health Home Maimonides Department of Psychiatry Administrative Data Brooklyn Health Home administrative data Maimonides Medical Center Hospital Community Service Plan ( ) 13

14 VI. DISSEMINATION OF THE PLAN TO PUBLIC This report, which includes our implementation strategy, is being made publicly available through our public web site ( The web site will be updated with more data and information regularly. VII. MAINTAINING COMMUNITY ENGAGEMENT Maimonides has historically (and currently) developed a very strong relationship with community- and faith-based leaders and organizations. These leaders and organizations are engaged on many levels by the hospital, ranging from the organization of community health symposia to engaging in dialogues about patient care needs to participating on advisory boards and committees at the hospital. This breadth of engagement runs through the fabric of our Institution and is critical to our success. Southwest Brooklyn has a rich history of education, advocacy and activism from community- and faithbased leaders and organizations. These organizations vary in their locus e.g. some are organized by faith, some by racial/ethnic makeup, some by education or school setting. Many of these organizations are well-poised to advocate for the health care needs of the communities they represent and do so on a regular basis. They often reach out to Maimonides Medical Center staff to express their needs, and viceversa. Every year, Maimonides hosts 1-2 meetings for the Council of Community Organizations (COCO), a congregation of various faith- and community-based groups and leadership from in and around the communities we serve in Southwest Brooklyn. The meeting features updates and discussions on pressing health care issues relevant to all the communities represented. Present at these meetings are rabbis, imams, pastors, community-based leaders, health care providers, area residents and often elected officials. Agenda items include new initiatives at the hospital and community aimed at improving health and well-being such as cancer screenings and follow up to open dialogue about health-related issues in the hospital. These meetings will be one avenue through which Maimonides will maintain community engagement. In addition, Maimonides convenes a consortium of health care providers, community-based organizations and social service providers as part of its leadership for the Brooklyn Health Home, a NYSdesignated Health Home. Together, this consortium has implemented a groundbreaking new approach to managing the care of chronically ill populations, with a particular focus on the seriously mentally ill. This group meets regularly to review progress on enrollment, clinical and administrative activity, and progress toward the stated goals of the initiative. Representatives from the BHH organizational members served as key informants during the interview phase. This group will also serve as an appropriate venue to which to share data and findings from our community health needs assessment. This consortium will also regularly be drawn on during the implementation period of the three year plan. Maimonides will draw on its internal data and analytical team to regularly review data on the health indicators described above to assess how its patient population and general community residents fare with respect to health and well-being. Progress toward benchmarks will be set and assessed through data review and analysis. Sources of data will include internal Maimonides electronic medical records and billing / registration systems and external New York City and State data sources cited earlier in this draft. For benchmarks where progress is not as anticipated, Maimonides planning team will identify and plan to implement any needed mid-course corrections. Maimonides Medical Center Hospital Community Service Plan ( ) 14